The opioid epidemic is an ongoing crisis that has severely impacted the United States. While the COVID-19 pandemic has been at the forefront of public health’s focus over the past year, the opioid epidemic has continued to intensify. There were 88,000 drug overdose deaths recorded from August 2019 to August 2020, a 27% increase — the highest number of overdose deaths ever recorded in a year-long period, according to the U.S. Centers for Disease Control and Prevention. Synthetic opioids are the primary driver of the increase in overdose deaths, rising 38.4% in the same time period compared with the year prior according to the Centers for Disease Prevention and Control.
We spoke with Shawna Bacon, Nurse Manager at Nexus Recovery Center in Dallas, Texas, to gain insight on the opioid epidemic from the frontlines, how technology can provide support, and the biggest obstacles facing the community.
Why do you think there’s been such a drastic increase in Opioid-related deaths, even before the start of the COVID-19 pandemic?
Bacon: “I think the biggest issue that has caused so many of the related deaths, even prior to the pandemic, is the fentanyl that's being mixed in. Here in Dallas we have had a large increase in the pressed pills where people are thinking they are taking percocets, but it's fentanyl and they don't realize it and then they overdose. It’s the common stigma that most people think it’s the homeless population, but it's everyone. It's someone's kid, it's someone's mom, grandma, grandparents.”
In your opinion, what aspects of Opioid addiction prevention and recovery are in the direst need for better funding, and why? (ie: If you were in charge of distributing resources, where would they go and why?)
Bacon: “As far as the funding situation, we don't have a lot of resources in Dallas, but at least we have some resources. Dallas is such a small dot on the map of the United States, there are many places that don't have many resources to get treatment, like a lot of the rural places. As far as where funding can be: of course treatment for these people, because out of pocket is expensive and private providers can charge ridiculous amounts and people can't afford that, and more housing available for people who are receiving medication, maintenance because they're still very limited. Those are the biggest things as far as funding the recovery support.”
What are your thoughts around peer to peer programs for recovery?
Bacon: “Peer recovery was actually started and based in Austin, at least in Texas it was starting as far as making it a little bit more where they have a training that the peer recovery coaches go to. It does help because it someone more available and someone who's kind of been there with the same thing the clients have been through. As far as the funding, yes they received the grant starting off you know as far as a program to help pay for these people to start, but I mean they can always use more support and make them more available. Some hospitals may have a peer recovery coach there, so when someone's coming into the hospital for an overdose or something that's use related then there's somebody there who can help them. And help them a little bit more than just saying okay you need to go get help but walking into helping them with the referrals.”
In your current role, how does your organization identify your highest risk patients?
Bacon: “With Nexus, we treat only women, so the first two of course our IV pregnant users and then pregnant and then IV drug use and then everyone else. Detox would come in above residential but as far as when we are bringing someone in any IV pregnant users, then pregnant, then IV drug users.”
Can you elaborate on what you mean by recovery support, since this may mean different things to various audiences?
Bacon: “All levels of care whether it be detox funding, inpatient residential, possibly longer residential, we have to fight you know with Medicaid at times to get extensions for people to even try to stay 28 days in residential, and outpatient treatment.”
Why do you think sober living and treatment centers have struggled so much with communication gaps?
Bacon: “Communication is a big hindrance. The sober living housing has gotten better in the last 2 years or so as far as people who are on maintenance medication, but there is still such a stigma of the maintenance based treatment. A lot of the people that are in the houses don't believe in maintenance treatment, so they don't want it around, they don't believe that somebody's actually in recovery being on medication, so it's just the education to any of those why they should allow people in with maintenance. There is always constant change. I may be able to get help for someone, because of networking like I know people in some place and I'm making that kind of relationship. A lot of the time it is just knowing who takes maintenance or who allows a mom to bring kids, instead of it just being kind of centralized.”
If you could wave a magic wand, what would you do right now to solve the opioid epidemic?
Bacon: “We need more providers to actually give maintenance. There's probably more obviously that just take cash payment, but again it goes to that funding where clients don't have that money. The hard thing is those providers don't take that funding. That's a big thing. There's plenty of doctors that may take cash payment, but there's very few that will take the state funding. It’s very limited and and then you get to the max that you can't take any more clients because you're at the max or they may only have so many slots for buprenorphine so then the only option that they may have is methadone and then of course I'd see no locally here but then of course not having providers that can treat people again in the middle of nowhere.”
Maintenance is a form of treatment for opioid users, also referred to as Medication Assisted Treatment. Individuals are prescribed methadone or buprenorphine drugs to control their addiction after they have become dependent on illegal opioid drugs. This treatment helps patients avoid going through serious withdrawals that could negatively impact their health. This treatment is traditionally paired with behavioral therapies to provide a holistic approach to sustainable sobriety.
What are your thoughts around the care provider role at a hospital? Is there something that should be happening there?
Bacon: “There's been some recent changes with eDoctors being able to prescribe buprenorphine without having to worry as much as far as their census or the amount of clients they can have having a waiver. I think with those changes it will make it easier that a provider in the ER can start someone on maintenance. The only thing is that it is a quick fix kind of thing. They go to the ER and get started on it but then the follow-through, I mean I haven't had one yet, but it's then ‘who's going to be contacting these emergency rooms?’ and ‘what's their plan?’. If they start someone, then ‘where are they sending that client to?’. If not then they're just going to keep that revolving door of going into the emergency room to try and get meds.”
Are there any apps or technological advancements that you see in other industries that you wish could be applied to opioid recovery?
Bacon: “They have mobile units in some places, but would that be something that could be done in those rural areas? For example, we have the Parkland med van, the homes outreach program that comes to our site. They have an RV that goes around to the different locations to give people medical care. Can we do something like that with maintenance but have it more so on a schedule of going out to all these middle of nowhere kind of areas for people to receive treatment?”
What are the biggest barriers in getting treatment for opioid users? What do you think are the biggest barriers to their recovery?
Bacon: “Education and the stigma against it. So I mean it's not just of course the person trying to receive help, but it's family education, the family support because the family may not have as much support because their family doesn’t understand it. The education to other providers and education to governmental agencies such as child protective services or any of the people that they may be involved with. Other providers may not realize and they may not understand how it works or where to send people to.”
How do you think technology can help support recovery for Opioid users? (ie, identifying and easing capacity issues, reporting, monitoring?)
Bacon: “Communication! More centralized communication to allow people to know but of course that's then trying to get everybody on board to use that centralized communication. The thought of it is ‘let’s get everybody on it’ but are they actually going to be able to use it, and there are so many different providers.”
Nexus Recovery Center is a nonprofit organization dedicated to breaking the cycle of addiction. Since 1971, Nexus has helped thousands of people overcome substance and alcohol abuse in order to lead healthy, productive, and rewarding lives. They are committed to supporting individuals and families by providing a wide range of services, from residential and outpatient treatment to continuing care and recovery support. Their specialized services include treatment for adult women, adolescent girls and their accompanying children.
About Shawna Bacon
Shawna Bacon works as a Nurse Manager at Nexus Recovery Center. She has been with Nexus for almost 9 years and has spent 19 years working in the field. Bacon shares that her “favorite thing is of course is seeing all the clients and the turn around, them coming back and saying they’ve been in recovery for so long, and when they get their kids back, and seeing babies being born. Just seeing the changes from the time they walk in the front door to even at the end of their stay here or even years on maintenance of what success that they have had.”